The ethical dilemmas health-care professionals dread seldom make it into the news. Difficult and divisive as abortion and euthanasia are, they aren’t the issues that keep medical practitioners awake at night.

Here are a few of the moral quandaries that do prey on their minds:

What do I do when budgetary constraints prevent me from offering a patient the treatment I know is right?

What do I say when an older patient manifests symptoms that strongly suggest
elder abuse
?

What do I tell a severely injured child who is the sole survivor of a horrific traffic collision?

What do I do if I witness a serious mistake by a senior clinician?

What do I tell the family of a patient whose health was compromised by a
medical error
?

Although these aren’t daily occurrences, they are part of the fabric of health care. Yet they are not discussed openly among medical practitioners and they are rarely mentioned in public.

Hoping to promote a dialogue within the profession and help outsiders understand the moral complexities of medicine,
Accreditation Canada
, the regulatory agency that certifies health-care and social service organizations, devoted the latest issue of its online magazine,
Qmentum Quarterly
, to ethics in health care. The objective, said chief executive Wendy Nicklin, was twofold: to help individuals work through ethical dilemmas and to help make the health-care system more transparent.

Five specialists (or groups) were invited to share their insight in different areas: medical education, patient safety, moral distress among health-care professionals, building an ethics framework and applying it in emergencies. The common thread running through all essays was that the worst thing health workers can do is bottle up their feelings.

McGill University
is testing a new program that goes beyond lectures and case studies. In 2012 it created a
simulation-based ethics course
, which gives pediatric residents a taste of the real-life dilemmas they will face. In one simulation, a family questions the value of the aggressive — and painful — treatment their child is receiving with no apparent results. In a second scenario, a single mother wants to care for her sick child at home to be with her other children while the medical team wants the child hospitalized in case of complications. In a third, a Muslim family refuses to allow sperm preservation before an adolescent son is treated for cancer, believing that masturbation is a sin.

Four contributors — two graduates and two professors — offered their assessment. “It increased (the residents’) level of comfort and preparedness for dealing with ethical issues,” they wrote. It also improved their ability to communicate difficult messages and earn the trust of patients and families.

They also polled participants. Without exception, they said they would recommend the course to their peers. Ninety-five per cent thought it should be mandatory.

The second segment focused on “moral distress” among health-care professionals. A
professor of child health
— a former pediatric oncologist — looked at the emotional price health workers pay when they are forced to compromise their standards. She outlined some of the factors that lead to such anxiety — financial constraints, hierarchical structures, patient preferences and institutional policies.

Two examples stood out: a nursing home employee driven by inadequate staffing to use medication and physical restraints instead of devoting extra time to agitated patients; and a medical team prevented from using life-saving procedures (
blood transfusions
for instance) by the beliefs of the patient or family.

Dealing with the guilt, anguish, isolation and disenchantment stemming from these events is essential to alleviate burnout and reduce the number of health-care workers leaving the profession, the author said. She recommended two processes — one for groups and one for sole practitioners — to work through the emotional turmoil.

The remaining three articles, while interesting, were targeted chiefly at health-care administrators. They examined ethics guidelines, protocols and support structures.

The aim of the publication was not be comprehensive; it was to illuminate the wrenching choices health professionals face and give users a more balanced view of the system.

On both counts, it succeeds. But days later, readers will find themselves asking: what would I have done?

Carol Goar
’s column appears Monday, Wednesday and Friday.

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